Noninvasive evaluation of renal tissue oxygenation with blood oxygen level-dependent magnetic resonance imaging early after transplantation has a limited predictive value for the delayed graft function

Purpose: The aim of this study was to evaluate the feasibility of renal oxygenation assessment using blood oxygen level-dependent (BOLD) magnetic resonance imaging (MRI) in the early period after kidney transplantation and to estimate its prognostic value for delayed graft function. Material and methods: Examinations were performed in 50 subjects: 40 patients within a week after the kidney transplantation and 10 healthy controls, using T2*-weighted sequence. Measurements in transplant patients were correlated to basic laboratory parameters in the early period after transplantation and at follow-up. Results: Examinations of seven patients (18%) were rejected due to their poor technical quality. Mean R2* values in transplant recipients were lower than in controls (11.6 vs. 15.9 Hz; p = 0.0001). An R2* value of 0.28 Hz was calculated as the minimal detectable change. There was no relation between R2* values and laboratory parameters. However, patients eGFR ≥ 40 ml/min/1.73 m2 presented higher R2* values than recipients eGFR 0.7). Conclusions: Evaluation of renal graft oxygenation using BOLD MRI is technically challenging in the early period after transplantation. An R2* value of 0.28 Hz may in practice be considered as the minimal detectable change. The delayed graft function seems not to be dependent on early oxygenation values. Further, large-scale studies are necessary to confirm the latter observation

Transplantacja nerki jako metoda leczenia nerkozastępczego pacjenta z przewlekłą chorobą nerek

Introduction. It is estimated that 500-600 million people are affected by chronic kidney disease. In Poland, 6500 among 4-5 million patients with chronic kidney disease require renal replacement therapy de novo every year. Renal transplant is a well-established treatment of end-stage chronic kidney disease, and the most effective one in comparison to alternatives – hemodialysis and peritoneal dialysis. Aim. Presenting the current condition of knowledge of issues is a purpose of the work to the subject chosen concerning transplanting kidneys as procedures in chronic nephropathy. Review. In this review the author presents the current state of knowledge about selected aspects of kidney transplantation in Poland from deceased and living donors, including transplantations from nonrelated living donors (Kidney Paired Donation program). Conclusions. Renal transplant allows to achieve both longer survival and better quality of life than dialysis and therefore is the treatment of choice in end-stage chronic kidney disease.Wstęp. Szacuje się, że przewlekła choroba nerek stanowi problem zdrowotny 500–600 milionów osób, z czego 4-5 milionów mieszkańców Polski, spośród których rocznie de novo 6500 wymaga leczenia nerkozastępczego. Transplantacja nerek jest uznaną metodą leczenia nerkozastępczego i najskuteczniejszą w porównaniu z alternatywnymi metodami leczenia przewlekłej choroby nerek - hemodializą i dializą otrzewnową. Cel. Celem pracy jest przedstawienie aktualnego stanu wiedzy na temat wybranych zagadnień dotyczących przeszczepiania nerek jako metody leczenia nerkozastępczego w przewlekłej chorobie nerek. Przegląd. W pracy przedstawiono aktualny stan wiedzy na temat wybranych zagadnień dotyczących transplantacji nerek w Polsce od dawców zmarłych i żywych, w tym przeszczepień od żywych dawców niespokrewnionych w ramach Programu Wymiany Par.  Podsumowanie. Transplantacja nerek zapewnia chorym dłuższe przeżycie i lepszą jakość życia niż dializoterapia, dlatego jest metodą z wyboru w leczeniu schyłkowej niewydolności nerek

Using digitalization for knowledge transfer in society is the future of transplantation: A pilot study

Introduction: Recently, knowledge about transplantation among the general public has diminished. The COVID-19 pandemic has worsened this transplantation-related crisis, but has simultaneously contributed to the greater development of online education. The aim of the study was the assessment of the level of general public knowledge regarding transplantation and suggesting new possibilities of utilizing digital forms of information transfer in the process of societal transplant education (STE).Material and methods: An online survey questionnaire, containing questions related to common transplantation knowledge, was conducted among students of faculties of medicine.Results: Nearly the entire study group indicated that increasing knowledge as regards organ transplantation may prove to have a significant impact with respect to donating organs after death for transplantation. The study revealed that over 60% of respondents held a false belief that a declaration of intent was a legally binding document rather than only a declaration of will. Over 20% of respondents erroneously believed that the donor’s family had the right to object to organ procurement for transplantation. Facebook, websites for patients and applications were indicated as effective forms of STE. Having obtained the results, the first Polish prototype of an “e-transplant” application was designed for thepurposes of STE.Conclusions: The level of knowledge concerning organ donation for transplantation is insufficient among the general public and necessitates the development of modern STE methods. All forms of information transfer in the virtual media space become particularly useful for the purposes of STE, including the created application

Psychological principles in regard to the interview with the deceased donor’s family

The purpose of this article is to present the most important rules of the interview process with the family of a patient who has been diagnosed with brain death. Based on data from the literature and their own clinical experience, the authors also describe the psychological mechanisms that make contact with the family of a potential donor particularly difficult. The paper also discusses successive stages in the process of building contact with the family from the perspective of the dual advocacy approach that, in the light of recent data from the literature, can significantly increase the likelihood of the family’s acceptance of organ donation, offering both the specific theoretical foundations as well as the strict principles in regard to the interview. The article contains practical suggestions for dealing with difficulties that can arise at all stages of contact with the family: making contact, providing information, providing information about brain death and talking with the family about organ donation from a deceased relative.The purpose of this article is to present the most important rules of the interview process with the family of a patient who has been diagnosed with brain death. Based on data from the literature and their own clinical experience, the authors also describe the psychological mechanisms that make contact with the family of a potential donor particularly difficult. The paper also discusses successive stages in the process of building contact with the family from the perspective of the dual advocacy approach that, in the light of recent data from the literature, can significantly increase the likelihood of the family’s acceptance of organ donation, offering both the specific theoretical foundations as well as the strict principles in regard to the interview. The article contains practical suggestions for dealing with difficulties that can arise at all stages of contact with the family: making contact, providing information, providing information about brain death and talking with the family about organ donation from a deceased relative

Kidney transplantation as a renal replacement therapy of patient with chronic kidney disease

Wstęp. Szacuje się, że przewlekła choroba nerek stanowi problem zdrowotny 500–600 milionów osób, z czego 4-5 milionów mieszkańców Polski, spośród których rocznie de novo 6500 wymaga leczenia nerkozastępczego. Transplantacja nerek jest uznaną metodą leczenia nerkozastępczego i najskuteczniejszą w porównaniu z alternatywnymi metodami leczenia przewlekłej choroby nerek - hemodializą i dializą otrzewnową. Cel. Celem pracy jest przedstawienie aktualnego stanu wiedzy na temat wybranych zagadnień dotyczących przeszczepiania nerek jako metody leczenia nerkozastępczego w przewlekłej chorobie nerek. Przegląd. W pracy przedstawiono aktualny stan wiedzy na temat wybranych zagadnień dotyczących transplantacji nerek w Polsce od dawców zmarłych i żywych, w tym przeszczepień od żywych dawców niespokrewnionych w ramach Programu Wymiany Par.  Podsumowanie. Transplantacja nerek zapewnia chorym dłuższe przeżycie i lepszą jakość życia niż dializoterapia, dlatego jest metodą z wyboru w leczeniu schyłkowej niewydolności nerek.Introduction. It is estimated that 500-600 million people are affected by chronic kidney disease. In Poland, 6500 among 4-5 million patients with chronic kidney disease require renal replacement therapy de novo every year. Renal transplant is a well-established treatment of end-stage chronic kidney disease, and the most effective one in comparison to alternatives – hemodialysis and peritoneal dialysis. Aim. Presenting the current condition of knowledge of issues is a purpose of the work to the subject chosen concerning transplanting kidneys as procedures in chronic nephropathy. Review. In this review the author presents the current state of knowledge about selected aspects of kidney transplantation in Poland from deceased and living donors, including transplantations from nonrelated living donors (Kidney Paired Donation program). Conclusions. Renal transplant allows to achieve both longer survival and better quality of life than dialysis and therefore is the treatment of choice in end-stage chronic kidney disease

Liver procurement from a brain-dead kidney transplant recipient — a case report

The shortage of organ donors has led to new strategies to increase the availability of allografts for transplantation, such as organ procurement from brain-dead organ transplant recipients. We present the case of a 26 year-old male brain-dead liver donor who had been a kidney transplant recipient six years previously. The liver donor described in this report, as the first in Poland, has paved a new, although as yet narrow, way in the field of organ donation. This is also the first case described in the medical literature of liver recovery from a brain-dead kidney transplant recipient on an immunosuppressive regimen with three immunosuppressive agents. Although transplant recipients represent an uncommon group of deceased organ donors, it is probable that situations when they may be considered as potential organ donors will occur more often. Therefore, although specific criteria for organ donors exist, each reported potential donor should be considered individually, and brain-dead solid organ recipients should not be excluded a priori as organ donors; both their native and allografted organs may be recovered and successfully transplanted. In this study, we also review the current state of knowledge on the reuse of organs.The shortage of organ donors has led to new strategies to increase the availability of allografts for transplantation, such as organ procurement from brain-dead organ transplant recipients. We present the case of a 26 year-old male brain-dead liver donor who had been a kidney transplant recipient six years previously. The liver donor described in this report, as the first in Poland, has paved a new, although as yet narrow, way in the field of organ donation. This is also the first case described in the medical literature of liver recovery from a brain-dead kidney transplant recipient on an immunosuppressive regimen with three immunosuppressive agents. Although transplant recipients represent an uncommon group of deceased organ donors, it is probable that situations when they may be considered as potential organ donors will occur more often. Therefore, although specific criteria for organ donors exist, each reported potential donor should be considered individually, and brain-dead solid organ recipients should not be excluded a priori as organ donors; both their native and allografted organs may be recovered and successfully transplanted. In this study, we also review the current state of knowledge on the reuse of organs